Category Archives: Anesthesia

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Pre-oxygenation/Pre-induction (some people don’t count this as a step)

Induction (putting them “to sleep”)

Maintenance (keeping them asleep)

Emergence (waking them up)

In North America, many physicians like to use a combination of an analgesic and a sedative followed by the induction agent propofol. Sometimes other agents are used for induction such as etomidate or ketamine, particularly if there is a worry about hemodynamic instability as propofol not uncommonly can cause bradycardia and/or hypotension.

If the patient is going to be intubated, a paralytic (muscle relaxant) is also used to relax the vocal cords to prevent unnecessary trauma as the tube is passed through them. Competitive acetyl choline (ACh) receptor antagonists such as rocuronium or succinylcholine are used for this. The main difference between the two is that succinylcholine is a depolarizing agent – meaning that when it first binds to the ACh receptor, it causes a contraction, whereas rocuronium is non-depolarizing – so when it binds nothing happens. So with this pesky contraction thing why would any one choose succinylcholine? The nice thing is that the half-life is much much shorter than rocuronium, so if things don’t work out quite the way you want them to, or you just want something fast, you don’t need to continue to help the patient breath.

Use: Generally considered a temporary vasopressor until more definitive therapy is begun. Useful for vasdilated patients with adequate cardiac output, for whom other vasopressors present risk of tachyarrhythmias.

The femoral triangle is a convenient triangle where the femoral nerve, artery and vein pass from the abdomen to the leg. The best part about this is that they’re all quite superficial, making it a great place to stick things in (place catheters, nerve blocks, etc).

Because the femoral triangle is often getting poked at for various reasons, it’s important to know what’s where because you don’t want to be hitting the nerve when you meant for the artery (or vice versa).

The triangle is made up by the sartorius, adductor longus and inguinal ligament and if you just remember NAVVAN.